Healthcare Provider Details

I. General information

NPI: 1952197527
Provider Name (Legal Business Name): CHRISTALINE STUDIOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537A N TRADE ST
WINSTON SALEM NC
27101-2914
US

IV. Provider business mailing address

537A N TRADE ST
WINSTON SALEM NC
27101-2914
US

V. Phone/Fax

Practice location:
  • Phone: 336-577-0157
  • Fax:
Mailing address:
  • Phone: 336-577-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTAL SCHANES
Title or Position: CEO AND FOUNDER
Credential:
Phone: 336-577-0157